| Doctor Name: | MR. KEVIN J MAXWELL |
| NPI Number: | 1003071952 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | 638 |
| Business Practice Address: | 1111 N Lee Ave Ste 105 Oklahoma City, OK - 731032620 |
| Business Phone Number: | 4056006730 |
| Business Fax Number: | 4056006750 |
| Mailing Address: | 1111 N Lee Ave Ste 105, OKLAHOMA CITY |
| State: | OK |
| Postal Code: | 731032620 |
| Phone Number: | 4056006730 |
| Fax Number: | 4056006750 |
| NPI Enumeration Date: | 07/21/2008 |
| NPI Last Update Date: | 06/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 638 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |